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Props to Elaine Grossman over at GSN for a fascinating story on Congressional concerns with the recently unveiled (Draft) National Response Framework. You might have to scroll down a bit to find it. We had a bit of chatter about the NRF on this blog, and perhaps this story will spark further discussion. The gist of the concerns about the plan -- oops, sorry, "framework" -- is that, well, it is not a plan but rather it is only a framework(!) And a not-so-clear one at that. Familiar critiques include: lack of clarity of roles and responsibilities -- even duplication and overlap; the use of ambiguous terminology and concepts; and a conspicuous absence of operational details which could provide useful guidance about implementation... DHS is also facing criticism for the lack of transparency in drafting/writing process for the document, which it vociferously denies, claiming that expertise and personnel across disciplines and agencies were brought to the table in crafting the NRF. Unless I'm misreading things, I do believe the general sense is that DHS has messed something up! This might be a good time, by the bye, to refer the, um, five of us to an informative report put out by NYU which highlights some of the legal and organizational incongruities cropping up as a result of recent legislation and an orientation towards the catastrophic. I bring it up here because it is an interesting piece to this changing puzzle we're dealing with, and for me anyway helps to clarify how it is that FEMA is really getting pushed and shoved all over the place in terms of its responsibilities, and equally: its capabilities.

One of the interesting stories coming out of these events relates to information management, and in particular to how information is communicated to victims (or potential victims) of disasters, and among various actors dealing with complex and rapidly changing situations. We have had posts in the past about risk communication, such as the new FEMA interactive flood maps that can be overlaid on Google Earth. The basic idea was that if people have a better understanding of the risks they face in moving to a certain neighborhood in a vulnerable area they will think twice. Two specific technical systems for communicating during a disaster have been mentioned repeatedly during the SoCal fires. One is so-called "Reverse 911" in which, apparently,  a central call center makes calls to home phones in certain geographic areas to warn them about location specific hazards or evacuation and rescue information. The service is provided by a private company whose system became operational in San Diego only a month ago. The other technology for real-time information sharing being employed is called WebEOC, made by a company in Georgia called ESi. It is described as a web 2.0 type of system that allows real time information sharing -- that is spatially arranged -- between many disperse points. ESi's description of the software can be found here. This is clearly aiming at the kind of "situational awareness" that emergency managers (and war fighters) in all times and places have wanted to have. The genealogical lines must, of course, go back to the military.

There is an interesting conference coming up at the New School. For more information go here.

Reporting from LA.... The southern CA firestorm is perhaps FEMA's first major test since Hurricane Katrina. A big task is the evacuation. There are multiple fires and they are traveling fast and in unpredictable ways. People sometimes want to stay to protect their houses in the absence of firefighters. One criticism likely to emerge is that the SD fire dept lacked resources, despite the known fire danger. Another - which is always noted after fires, but does not seem to affect development - is that people should not be allowed to build houses in these zones. So far it seems that the evacuation has been handled in a very different way than New Orleans. According to reports, the 20,000 people in Qualcomm stadium are well-fed, the national guard is there with automatic weapons in case of social disorder. On the other hand it is not clear that there are sufficient resources available for people showing up in evacuation centers, such as the race track in Del Mar. This is a very different situation than Katrina, of course. First, the city is not totally engulfed: most of its infrastructure (communications, electricity, transportation) is operational. Second, the race and class dynamic is different: many of the burned and threatened areas are wealthy suburbs, and residents have resources and networks to find adequate accommodations after evacuating. Third, state and federal leaders know they are under scrutiny and must demonstrate quick response (not to mention that the CA governor is from the same party as the president). FEMA has set up a Joint Field Office in Pasadena; USNORTHCOM, the Red Cross, etc are in action. A lot now depends on how much longer the heat and Santa Ana winds continue....

Oct 22, 2007 (CIDRAP News) The White House recently issued a lengthy homeland security directive aimed at bolstering the response of federal, state, and local public health systems to national emergencies such as bioterrorist attacks, influenza pandemics, and natural disasters.

The directive, titled "Homeland Security Presidential Directive 21 (HSPD 21)," will "transform our national approach to protecting the health of the American people against all disasters," the document states.

"Ultimately, the Nation must collectively support and facilitate the establishment of a discipline of disaster health," the directive asserts.

The directive was published on the White House Web site on Oct 18 and is the latest in a series of executive orders issued since Sep. 11, 2001, to protect the nation in the event of terrorist attacks or other "catastrophic health events."

The directive says strategic improvements across government levels can better prepare the nation to "deliver appropriate care to the largest possible number of people, lessen the impact on limited healthcare resources, and support the continuity of society and government."

The directive covers four main topics: biosurveillance, countermeasure stockpiling and distribution, mass-casualty care, and community resilience. Each area contains specific actions and timelines.

BiosurveillanceThe directive calls on the secretary of the Department of Health and Human Services (HHS) to establish a national epidemiologic surveillance system that builds on existing networks and provides public health agencies with incentives to build new systems where there are gaps.

HHS, with the assistance of other federal agencies, has been asked to establish a federal epidemiologic surveillance advisory committee task force within 180 days. The task force will include federal, state, local, and private sector representatives.

Countermeasure stockpiling and distributionAmong several measures to improve distribution plans and more closely manage stockpiles, the directive orders HHS and the Department of Homeland Security (DHS) to develop templates to help communities dispense medical countermeasures within 48 hours of an official order. The initial template should be published within 270 days and include performance standards to measure state and local response, along with a system for annually evaluating local readiness.

Within 180 days after the template actions are completed, HHS and DHS will start collecting and using performance data on state and local distribution systems to guide future decisions on public health preparedness grants.

HHS, with assistance other federal agencies, will develop within 270 days plans to help states and localities that aren't able to sufficiently deploy countermeasures in a catastrophic health event.

To better manage the nation's Strategic National Stockpile (SNS) of drugs and medical supplies, HHS will ensure transparency concerning stockpiling priorities and, with input from other federal agencies, will establish a system within 180 days to annually review SNS inventories.

Within 180 days, HHS and other federal agencies will develop protocols for sharing countermeasures and medical goods between the SNS and other federal stockpiles and will explore developing reciprocal stockpile-sharing arrangements with other countries and international organizations.

Also, within 90 days HHS will establish a process for sharing information about the SNS with government agencies and health officers who need to know and have proper clearance.

Mass-casualty careThe directive orders HHS, in coordination with the Defense, Veterans, and Homeland Security departments, to engage the help of state, local, academic, professional, and private groups in reviewing the nation's disaster medical system and surge capacity. Within 270 days, HHS is to submit a report on gaps in those two areas and give the White House a plan that addresses key deficits.

HHS has also been asked to define, within 180 days, how federal facilities can be factored more effectively into medical surge-capacity plans.

To address potential legal, regulatory, or other barriers to public health preparedness, HHS, working with other agencies, must within 120 days submit a report on possible regulatory or legislative solutions to the White House.

Recognizing that addressing mental health consequences of a disaster—the "worried well"—

can contribute to a more effective public health response, the White House asked the HHS and other agencies to put together a federal advisory committee on disaster mental health within 180 days. The directive states that a report from the committee is due within 180 days after the group is formed.

Community resilienceHHS, along with the Defense, Commerce, Labor, Education, Veterans, and Homeland Security departments, is ordered to develop a plan to promote community preparedness and present it to the White House in 270 days.

DHS and HHS are assigned to develop a risk-awareness briefing for state and county officials within 150 days and, within 180 days, establish a mechanism to regularly update the public health risk briefings.

Within 180 days, HHS and DHS will develop and maintain a process for coordinating federal grant programs for public health and medical preparedness.

To further bolster preparedness, HHS and other agencies have been asked within the next year to develop core curricula and training exercises on disaster preparedness for federal executive departments and agencies. The materials are to designed to be usable by state and local governments as well as education and the private sector.

The directive calls for setting up, within the next year, the "National Center for Disaster Medicine and Public Health" at the Uniformed Services University of the Health Sciences in Bethesda, Md. The center is to lead federal efforts to develop core curricula, training, and research in various aspects of civilian and military medical preparedness.

The White House has asked HHS, within 180 days, to commission the Institute of Medicine to lead a forum to engage government officials, academic experts, professional societies, and private stakeholders in developing "a strategy for long-term enhancement of disaster pubic health and medical capacity" and the propagation of related training.

Within 120 days, HHS will submit to the White House a plan to use current funding programs to create incentives for private health facilities to enact preparedness measures that don't increase healthcare costs.

The directive also establishes an Office for Emergency Medical Care within HHS to promote and fund emergency medicine research, promote regional emergency medicine partnerships, and promote local preparedness.

See also:

Oct 18 Homeland Security Presidential Directive 21http://www.whitehouse.gov/news/releases/2007/10/20071018-10.html

This does not meet our usual standards of seriousness but was too funny to pass up. The Onion on a Jell-O attack by conceptual terrorists on the Sears Tower. A great line: "The DHS said it has taken additional measures to secure the Brooklyn Bridge following today's Jell-O attack, as initial evidence suggests that the New York landmark may or may not be the site of "found terrorism."

An article in today's Times reports on a study of invasive MSRA infections contracted in health facilities. The results were published in the Journal of the American Medical Association. The study estimates that nearly 19,000 deaths in the United States can be traced to such infections (which are resistant to front-line antibiotics) every year, and found that they are contracted in a range of health facilities beyond hospitals. The remedy is simple hygienic practices (such as washing hands -- which health care professionals do with astonishing infrequency, according to the article) and better surveillance by hospitals so that performance can be benchmarked.

I haven't had a chance to read this yet, but thought it was interesting: An Investor's Guide to Avian Flu Found it on the UPMC Center for Biosecurity site in a page they have for a 2005 conference on avian flu and the private sector.

Science reports on a recent Congressional hearing concerning the "proliferation" of biocontainment labs in the six years since the anthrax letters.  While BSL-3 and BSL-4 labs have sprung up in response to newly perceived biological threats, the GAO argues that these labs are themselves a source of threat.  Reflexive modernity in action:  "in a harsh critique, a government auditor told Congress today that the uncontrolled expansion of new biocontainment facilities has itself made the country more vulnerable to accidents and bioterrorism. Federal officials agreed that they need to take steps to improve safety."

There is an article in today's New York Times on anthropologists working in counterinsurgency operations in Afghanistan